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Guideline

Ministry of Health, NSW


73 Miller Street North Sydney NSW 2060
Locked Mail Bag 961 North Sydney NSW 2059
Telephone (02) 9391 9000 Fax (02) 9391 9101
http://www.health.nsw.gov.au/policies/

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Maternity Management of Pregnancy Beyond 41 Weeks Gestation


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Document Number GL2014_015
Publication date 23-Jul-2014
Functional Sub group Clinical/ Patient Services - Maternity
Summary The purpose of this document is to provide guidance for the clinical
management and provision of evidence based information to women with
low risk, singleton pregnancies that extend beyond 41+0 weeks
gestation. It is important to assess each woman individually and base the
management plan for pregnancy beyond 41+0 weeks on her specific
circumstances and preferences.
Author Branch NSW Kids and Families
Branch contact NSW Kids and Families 02 9424 5866
Applies to Local Health Districts, Specialty Network Governed Statutory Health
Corporations, Public Health Units, Public Hospitals
Audience All Clinicians in Maternity Services
Distributed to Public Health System, Divisions of General Practice, NSW Ambulance
Service, Ministry of Health, Private Hospitals and Day Procedure Centres,
Tertiary Education Institutes
Review date 23-Jul-2019
Policy Manual Patient Matters
File No. 13/2274
Status Active

Director-General

GUIDELINE SUMMARY

MATERNITY - MANAGEMENT OF PREGNANCY


BEYOND 41 WEEKS GESTATION
PURPOSE
The purpose of this document is to provide guidance for the clinical management and
provision of evidence based information to women with low risk, singleton pregnancies
that extend beyond 41+0 weeks gestation. It is important to assess each woman
individually and base the management plan for pregnancy beyond 41+0 weeks on her
specific circumstances and preferences.

KEY PRINCIPLES
Effective communication between health care professionals and women is essential.
Information should be offered regarding the risks associated with prolonged
pregnancies, and the options available. This will help women to make an informed
choice, based on her individual preferences and circumstances for either a scheduled
induction for a pregnancy beyond 41+0 weeks or expectant management.
Women should be informed that most women will go into labour spontaneously by 42+0
weeks gestation. The use of early gestational scans to calculate the estimated date of
birth can lower the rate of pregnancy beyond 41+0 weeks in women. If pregnancy is
prolonged, additional fetal surveillance and management plans should be discussed
with the woman and clearly documented in the womans antenatal record.
The information discussed should include:
The risks and benefits of membrane sweeping during a vaginal examination, as
described in Section 2.2.1 of this document
The risks and benefits of expectant management, as described in Section 2.3.1
of this document
The need for increased fetal surveillance from 41+0 weeks, as described in
Section 2.4 of this document
The risks and benefits of induction of labour, as described in Section 2.5.1.

USE OF THE GUIDELINE


This guideline will describe clinical management of pregnancies beyond 41+0 weeks
gestation for otherwise low risk women with singleton pregnancies. The terms
postdates, post term and overdue will not be used in this document as these terms are
often used interchangeably and can be misleading.

REVISION HISTORY
Version
July 2014
(GL2014_015)

GL2014_015

Approved by
Deputy Secretary
Population Health

Amendment notes
New Guideline

Issue date: July-2014

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GUIDELINE SUMMARY

ATTACHMENTS
1. Maternity Management of Pregnancy Beyond 41 Weeks Gestation - Guideline

GL2014_015

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MATERNITY
MANAGEMENT OF
PREGNANCY BEYOND
41 WEEKS GESTATION
NSW Health Guideline

Maternity - Management of Pregnancy


Beyond 41+0 Weeks Gestation

CONTENTS
1. BACKGROUND ....................................................................................................................1
1.1 Purpose.........................................................................................................................1
1.2 Context..........................................................................................................................1
1.3 About this document......................................................................................................1
1.4 Key definitions ...............................................................................................................1
1.5 Tiered Maternity Networks.............................................................................................2
1.6 Calculating the estimated date of birth...........................................................................2
1.7 Considerations for women living in rural and remote areas ........................................... 3
2. MANAGEMENT OF PREGNANCY BEYOND 41+0 WEEKS GESTATION............................ 3
2.1 Non-medical options to stimulate labour ........................................................................3
2.2 Membrane sweeping .....................................................................................................4
2.2.1 Risks and benefits of membrane sweeping ........................................................4
2.3 Expectant management pregnancy beyond 41+0 weeks ................................................4
2.3.1Risks and benefits of expectant management ...............................................................5
2.4 Fetal surveillance from 41+0 weeks gestation.................................................................5
All pregnant women should be routinely provided with verbal and written information
regarding normal fetal movements at each point of contact during the antenatal period. This
information should be reinforced for the management of potential prolonged pregnancies39. 6
2.5 Induction of labour between 41+0 and 42+0 weeks gestation .......................................... 6
2.5.1Risks and benefits of induction of labour .......................................................................7
2.5.2Service capability for induction of labour .......................................................................7
3. WOMAN CENTRED CARE...................................................................................................8
3.1 Information and decision making ...................................................................................8
3.2 Documentation ..............................................................................................................8
4. REFERENCES......................................................................................................................9
5. ATTACHMENT 1 ................................................................................................................11

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Contents Page

Maternity - Management of Pregnancy


Beyond 41+0 Weeks Gestation

1.

BACKGROUND

1.1

Purpose

The purpose of this document is to provide guidance for the clinical management and provision of
evidence based information to women with low risk, singleton pregnancies that extend beyond
41+0 weeks gestation. It is important to assess each woman individually and base the
management plan for pregnancy beyond 41+0 weeks on her specific circumstances and
preferences.
This guideline should be read in conjunction with the following NSW Policy Directives and
Guidelines:
Policy Directive 2010_045 Maternity - Towards Normal Birth in NSW
Guideline GL2011_012 Maternity - Decreased Fetal Movements in the Third Trimester
Policy Directive 2011_075 Maternity - Oxytocin for the Induction of Labour at or Beyond
Term
Guideline GL2014_004 Maternity - Supporting women in their next birth after caesarean
section (NBAC)

1.2

Context

In Australia in 2010, 91.7% of women who gave birth did so at 37+0 41+0 weeks of gestation and
0.8% gave birth at 42+0 or more weeks gestation (this includes spontaneous or induced labour
and births by caesarean section)1.
Evidence suggests that the overall perinatal mortality rate increases with increasing maternal2
and gestational age in late term pregnancies. However, the absolute risks of adverse events
associated with the increase of gestational age are small3.
The reduction in these adverse perinatal outcomes can be achieved if birth occurs prior to 42+0
weeks gestation. However, there is clinical debate with regards to the risks and benefits of
awaiting spontaneous labour compared to induction of labour and at what gestational age
induction should occur4.

1.3

About this document

This guideline will describe clinical management of pregnancies beyond 41+0 weeks gestation for
otherwise low risk women with singleton pregnancies. The terms postdates, post term and
overdue will not be used in this document as these terms are often used interchangeably and
can be misleading. The term completed weeks will not be used as it can also be misleading.
A review of the literature found a range of research papers, systematic reviews, evidence-based
clinical practice guidelines and expert consensus describing international best practice for
management of pregnancy beyond 41+0 weeks gestation. This literature has been used to inform
this guideline. Relevant references are provided at the end of this guideline.
This Guideline has been endorsed by the Maternal and Perinatal Health Priority Taskforce.

1.4

Key definitions

Pregnancy beyond 41+0 weeks - pregnancy that extends beyond 41+0 weeks gestation (i.e. at
least 1 week past the estimated date of birth).

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Should indicates actions that are to be followed unless there are justifiable and documented
reasons for taking a different course of action.

1.5

Tiered Maternity Networks

Management of pregnancy beyond 41+0 weeks gestation should be undertaken within a maternity
service with the appropriate service capability. Consultation and referral pathways should be in
place to facilitate the womans movement between services within their Tiered Maternity Network.

1.6

Calculating the estimated date of birth

For the purposes of this guideline pregnancy gestation will be calculated using 40 calendar
weeks from date of last menstrual period (LMP).
The ability to estimate the range of dates during which birth may occur is influenced by: the
regularity and length of a womans menstrual cycle, whether the date of ovulation (rather than
that of intercourse) is known and the timing of any ultrasound assessment (see Table 1).
It should be noted that the estimated date of birth (EDB) is only an estimate and therefore should
not indicate one particular day that a baby can be born. Evidence suggests only 5% of babies are
born on their due date, with a further 66% born 7 days either side of this date6. It is
recommended that as soon as the pregnancy is dated, and throughout the pregnancy, that the
discussion with the woman confirms the 2-week period during which their baby may be born and
that the woman is aware there is only a 35% chance that they will actually go into labour during
the week of their EDB (+/-3 days)5.
For in-vitro fertilisation (IVF) pregnancies, the age and date of embryo transfer should guide the
EDB; subsequent ultrasound scans should not be used.
Accurate pregnancy dating is based on the information at Table 1, outlined in the National Clinical
Practice Guidelines: Antenatal Care-Module 1 (such algorithms are generally incorporated into
most databases) 6,7,8,9 :
Table 1 LMP vs Ultrasound as a predictor for EDB based on known LMP and regular menstruation
(21-35 days)

Known LMP and regular menstruation (21-35 days)

Unknown
LMP, irregular
menstruation

Gestation
LMP and
LMP and
LMP and
LMP and
at
U/S dates
U/S dates
U/S dates
U/S dates
ultrasound differ by
differ by
differ by
differ by
(U/S)
5 days
>5 days
10 days
>10 days
Not
applicable
Not applicable
6-13/40
LMP
U/S date
U/S date
weeks
Not applicable
Not applicable
13-24/40
LMP
U/S date
weeks
24/40
LMP
LMP
LMP
LMP
weeks
Note: If no LMP dates or ultrasound dating is available, the decision regarding pregnancy dating
should be made by the most experienced clinician providing the womans antenatal care.

Recommendation:
Expectant mothers should be informed that there is only a 35% chance that they will actually
go into labour during the week of their estimated date of birth (+/-3 days). Maternal anxiety
may be alleviated if a range of dates (for example 38+0- 42+0 weeks) is substituted for a specific
date of delivery, with the optimal time for birth being approximately 40+0 weeks gestation.
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Considerations for women living in rural and remote areas

1.7

In remote regions, it may be difficult for women to access ultrasound examination early in
pregnancy. This may be due to limited availability of adequate equipment or ultrasound, a lack of
accredited and trained professionals, and the costs involved for the woman in travelling for the
assessment. Health professionals should therefore ensure that initial history taking is
comprehensive and detailed and that ongoing assessment of fetal growth and wellbeing is
undertaken.
The agreed due date should not be changed without advice from a senior maternity clinician. Any
changes should be clearly documented in the womans antenatal record.
Accurately assessing gestational age is particularly important for women living in rural and
remote areas and for Aboriginal and Torres Strait Islander women as:

many women live in rural and remote areas and move to a larger centre to give birth,
requiring logistical arrangements to be made around the estimated date of birth (The
Isolated Patients Travel and Accommodation Assistance Scheme [IPTAAS] may be
able to subsidise travel and accommodation for women in rural and remote areas to
access maternity care and services in some circumstances) 10;
Aboriginal and Torres Strait Island women have higher rates of preterm birth and
intrauterine growth restriction6.

2.

MANAGEMENT OF PREGNANCY BEYOND 41+0 WEEKS


GESTATION

2.1

Non-medical options to stimulate labour

There are some non-medical/complementary options that women may explore to stimulate
labour11,12,13,14,15,16. Although evidence is limited to support most of these options clinicians will
need to be familiar with these options so that they are able to advise women appropriately. The
interventions are outlined in the table below.
Table 2 Non-medical options to stimulate labour the evidence and risks

Non-medical
intervention
Date Fruit11
Castor Oil16
Sexual Intercourse15
Breast Stimulation14

Acupuncture12
Homoeopathy13

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Evidence
Insufficient evidence
Insufficient evidence to make any conclusion
regarding the effectiveness as an induction agent
Insufficient evidence to make any conclusion
regarding the effectiveness as an induction agent
Beneficial in terms of:
Reduction in the number of women not in
labour after 72 hours with a favourable cervix.
Reduction in postpartum haemorrhage
Insufficient evidence describing the efficacy as an
induction of labour agent. However some evidence
of change in cervical ripening
Insufficient evidence to recommend as a method
of induction of labour

Issue date: July-2014

Risks
Diarrhoea
Nausea,
diarrhoea

Should not be
used in high-risk
women

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Membrane sweeping

2.2

Procedures for cervical ripening, such as membrane sweeping, may be of benefit in preventing
pregnancy beyond 41+0 weeks, particularly in first pregnancies17. Membrane sweeping involves
the health professional introducing a finger into the cervical os and sweeping it around the
circumference of the cervix during a vaginal examination, with the aim of separating the fetal
membranes from the cervix and triggering the release of prostaglandins3. This can lead to
softening of the cervix and augmenting oxytocin-induced uterine contractions4.
One-off routine sweeping of the membranes has not been shown to reduce the number of women
requiring induction of labour for pregnancy beyond 41+0 weeks4. A Cochrane review concluded
there is little justification for performing routine sweeping of membranes for women near term (37
to 40 weeks of gestation) in an uncomplicated pregnancy18. Another study recommends
sweeping of the membranes to commence from 41+0 weeks gestation every 48 hours until
spontaneous labour occurs, or until the woman reaches 42+0 weeks gestation19. In this study,
serial sweeping of the membranes decreased the risk of pregnancy reaching 42+0 weeks
gestation.

2.2.1 Risks and benefits of membrane sweeping


Membrane sweeping does not appear to increase the risk of maternal or fetal complications (e.g.
infection)18,19,20. Before formal induction of labour, women should be offered membrane sweeping,
following a discussion of risks and benefits3.
Risks

Benefits of regular membrane sweeping

May not be successful and some women may


find it painful: however, women describe the
procedure as more acceptable than induction
of labour 19

May result in the woman going into


spontaneous labour18

Uncomplicated vaginal bleeding or irregular


contractions may occur following the
procedure19.

Softens the cervix and may reduce the need


for induction of labour18.

Recommendation:

2.3

Membrane sweeping should be discussed with women from 40+0 and offered from 41+0
weeks gestation. It can be repeated regularly (based on individual clinical need and
local protocols) until spontaneous labour occurs, or induction of labour is indicated.
Where a woman requests membrane sweeping earlier than 41+0 weeks, she should be
advised of the risks and benefits (as above) and the reason for the procedure
documented in the womans clinical record by her care provider19.

Expectant management pregnancy beyond 41+0 weeks

Following discussion with their maternity carer, women may choose expectant management for a
potential pregnancy beyond 41+0 weeks. Women should be counselled regarding the need for
increased surveillance beyond 41+0 weeks for mother and baby (see Section 2.4) as well as the
associated risks as described in Section 2.3.1 of this document. The discussion with the woman
along with any agreed management plans should be documented in the womans clinical record.

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2.3.1 Risks and benefits of expectant management


The benefits of expectant management are associated with the woman going into spontaneous
labour and achieving a normal birth. These include:

Increased maternal satisfaction when there is a support of maternal choice


Skin to skin contact which can enhance mother-infant bonding and wellbeing 21
Increased potential for an uncomplicated birth in future pregnancies
Less likelihood of interventions such as forceps or vacuum assisted birth 22
Shorter recovery time and hospital stay.

The risks of expectant management are associated with the woman not going into spontaneous
labour, extending the pregnancy further towards 42+0 weeks gestation and therefore increasing
the risk of interventions such as induction of labour and/or caesarean section. The risks include
increased:

Maternal anxiety, particularly if the woman perceives her pregnancy beyond 41+0
weeks as high risk 23, 24
Risk of potential harm from unnecessary interventions resulting from false-positive
test results associated with increased fetal surveillance 25
Increased risk of prolonged labour
Incidence of trauma to the pelvic floor, vagina and perineum due to fetal macrosomia
23, 26

2.4

Risk of caesarean section 26, 27, 28, 29


Incidence of postpartum haemorrhage 27, 28,29
Perinatal mortality. The perinatal mortality rate at 40 weeks gestation approximately
doubles by 42+0 weeks (23 deaths versus 47 deaths per 1,000 births) and
increases by 6-fold and higher at 43 weeks and beyond19. Perinatal mortality rates
also appear to increase with advancing maternal age2.
Risk of other complications has also been reported30,31,32, including:
meconium aspiration syndrome
oligohydramnios
central nervous system damage
macrosomia and associated complications (cephalopelvic disproportion,
shoulder dystocia and birth injury).

Fetal surveillance from 41+0 weeks gestation

Increased fetal and maternal surveillance aims to reduce the risk of adverse outcomes and
ensure timely induction of labour if indicated (eg fetal compromise or oligohydramnios).
Assessments for fetal surveillance to detect potential placental insufficiency may include
cardiotocography and ultrasound to examine amniotic fluid index (AFI), Doppler studies and/or
biophysical profile 33,34,35,36,37.
Whilst the literature suggests cardiotocography and Doppler have no significant benefit in
predicting outcomes for pregnancies beyond 41+0 weeks35, international guidelines recommend
increased antenatal surveillance from 41+0 weeks 3,23. Consensus and expert opinion cited in
these guidelines recommended twice weekly4 assessment of fetal welfare from 41+0 weeks
gestation including as a minimum:
The estimation of amniotic fluid volume to provide valuable information regarding the
placental function over the preceding week26 and
The evaluation of the antenatal fetal heart rate pattern to provide information on the
fetal condition at the point of time of testing26

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A specialist referral or consultation is required once the woman reaches 42+0 weeks
gestation38.

All pregnant women should be routinely provided with verbal and written information regarding
normal fetal movements at each point of contact during the antenatal period. This information
should be reinforced for the management of potential prolonged pregnancies39.
Note: When initiating fetal surveillance from 41+0 weeks gestation, clinicians should consider the
timing of the 41st week of gestation review. Where services are operating at reduced capacity, for
example over a weekend or public holiday, fetal surveillance should be conducted within working
hours prior to the period of closure or reduced service availability.

Recommendation:

2.5

From 41+0 weeks, women should be offered evaluation of the antenatal fetal heart rate
pattern twice weekly
From 41+0 weeks, women can be offered ultrasound assessment of amniotic fluid volume
Specialist referral or consultation is required once the woman reaches 42+0 weeks
gestation38
All plans for fetal surveillance should be recorded in the womans ongoing management
plan
All pregnant women should be routinely provided with verbal and written information
regarding normal fetal movements at each point of contact during the antenatal period.

Induction of labour between 41+0 and 42+0 weeks gestation

Induction of labour for pregnancy between 41+0 and 42+0 weeks gestation has been shown to
reduce the caesarean section rate with a lowering of perinatal mortality and morbidity when
compared to expectant management4. Systematic reviews40,41 found that compared with a policy
of expectant management, a policy of induction of labour was associated with lower rates of (all cause) perinatal death, meconium aspiration syndrome and caesarean section.
Clinical decisions for induction of labour for pregnancies beyond 41+0 weeks should be discussed
with the woman in consultation with an obstetrician. Women should be counselled about the risks
and benefits of induction of labour26, with consideration also being given to the womans
circumstances and preferences.
Induction of labour for women with a history of previous caesarean section should only be
undertaken with caution, with the decision led by an obstetrician in consultation with the
woman27,42.

Recommendation:
Following a detailed discussion of the risks and benefits of induction of labour with the woman,
induction of labour should be offered to women and ideally scheduled between 41+0 and 42+0
weeks gestation.

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2.5.1 Risks and benefits of induction of labour


Induction of labour should be considered as an option when the risks to the mother and/or baby
of ongoing pregnancy outweigh the risks of induction of labour and birth.
The risks and benefits include:
Risks

Benefits

Induction of labour may lead to further


interventions that can include emergency
caesarean section and assisted vaginal
delivery22,27

Opportunity for bonding achieved through


skin-to-skin contact may be reduced if
interventions such as emergency
caesarean section are required 21

Postpartum haemorrhage43

The induction of labour process may be


delayed depending on clinical activity and
available resources.

In pregnancy beyond 41+0 weeks,


induction of labour has been shown to
reduce perinatal mortality rate (see
Section 2.5).

2.5.2 Service capability for induction of labour


LHDs must ensure that medical induction of labour or augmentation with oxytocin (Syntocinon)
should only occur in units where their service capability includes the ability to perform an
emergency caesarean section 44.
All NSW Public Health Organisations providing maternity services should have clinical practice
guidelines and protocols for the use of oxytocin for the induction of labour in pregnancy beyond
41+0 weeks (see Policy Directive 2011_075 Maternity - Oxytocin for the Induction of Labour at or
Beyond Term) 27. Such clinical practice guidelines and protocols should reflect an LHD wide,
standardised, evidence-based approach to the induction of labour. The LHD guideline should
reflect the appropriateness of the procedure in line with the service capability of each maternity
service with detailed escalation pathways for consultation and referral.

Recommendation:
Consideration should be given to the availability of clinical resources when planning the
most suitable gestation for induction of labour in line with the facilitys service capability
In the case of women with a history of previous caesarean section LHDs should ensure
that medical induction of labour or augmentation with oxytocin occurs in line with the
service capability of the facility27.

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3.

WOMAN CENTRED CARE

3.1

Information and decision making

Effective communication between health care professionals and women is essential. Information
should be offered regarding the risks associated with prolonged pregnancies, and the options
available. This will help women to make an informed choice, based on her individual preferences
and circumstances, for either a scheduled induction for a pregnancy beyond 41+0 weeks or
expectant management.
Women should be informed that most women will go into labour spontaneously by 42+0 weeks
gestation27. The use of early gestational scans to calculate the estimated date of birth can lower
the rate of pregnancy beyond 41+0 weeks in women7. If pregnancy is prolonged, additional fetal
surveillance and management plans should be discussed with the woman and clearly
documented in the womans antenatal record.
The information discussed should include:
The risks and benefits of membrane sweeping during a vaginal examination, as
described in Section 2.2.1 of this document
The risks and benefits of expectant management, as described in Section 2.3.1 of this
document
The need for increased fetal surveillance from 41+0 weeks, as described in Section 2.4 of
this document
The risks and benefits of induction of labour, as described in Section 2.5.1.
Clinicians should advise that management decisions can be made after the woman has an
opportunity to consider the risks, benefits and her personal preferences.
Clinicians should be aware of the potential for women to experience anxiety if pregnancy is
prolonged. There should also be consideration for practical difficulties for the woman for
example, when the woman has to travel to give birth or needs to arrange for additional support
of her children or other family members. Additional advice and support may be required in these
situations such as relevant community supports and financial assistance programs particularly
for women who are not eligible for Medicare. Social workers, where available, may be able to
assist women further.
Communication should be supported by evidence-based written information, where possible,
tailored to the needs of the individual woman. Treatment, clinical care, and information provided
should be culturally appropriate. Information should also be accessible to women, their partners
and families, taking into account any additional needs such as physical or cognitive disabilities,
and inability to speak or read English.
The Management of pregnancy beyond 41+0 weeks gestation consumer information
brochure (Attachment 1) is available to guide and support the discussions regarding the
available options for care. Consideration should be given to using interpreters to relay this
information to women from culturally diverse backgrounds.

3.2

Documentation

All documentation in the womans medical record should be in line with PD2012_069 Health Care
Records - Documentation and Management. Any discussion regarding the risks and benefits for
the management of pregnancy beyond 41+0 weeks gestation should be recorded in the womans
antenatal record. Documentation should include the details of the discussion, options presented
to the woman and the agreed management plan.

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4. REFERENCES
1. Li Z, Zeki R, Hilder L et al (2012) Australias Mothers and Babies 2010. Cat. no. PER 57.
Sydney: Australian Institute for Health and Welfare National Perinatal Epidemiology and
Statistics Unit.
2. Page JM, Snowden JM, Cheng YW, Doss AE, Rosenstein MG, Caughey AB(2013). The
risk of stillbirth and infant death by each additional week of expectant management
stratified by maternal age. Am J Obstet Gynecol. Oct;209(4):375.e1-7
3. NICE (2008) Antenatal Care. Routine Care for the Healthy Pregnant Woman. . National
Collaborating Centre for Womens and Childrens Health. Commissioned by the National
Institute for Health and Clinical Excellence. London: RCOG Press.
4. SOGC Clinical Practice Guideline. Guidelines for the Management of Pregnancy at 41+0 to
42+0 Weeks. Guideline No. 214. Ottawa: 2008
5. Khambalia, A., Roberts, C., Nguyen, M., Algert, C., Nicholl, M., Morris, J. (2013),
Predicting date of birth and examining the best time to date a pregnancy. International
Journal of Gynaecology and Obstetrics. 123(2), 105-109.
6.

Australian Health Ministers Advisory Council 2012, Clinical Practice Guidelines: Antenatal
Care Module 1. Australian Government Department of Health and Ageing, Canberra.
http://www.health.gov.au/antenatal.

7. Altman DG, Chitty LS. New charts for ultrasound dating of pregnancy. Ultrasound Obstet
Gynecol 1997;10:174191.
8. Campbell Westerway S (2000) Ultrasonic fetal measurements. Aust NZ J Obstet Gynaecol
40: 297302.
9. Callen PW (2008) Ultrasonography in Obstetrics and Gynaecology. 5th ed. Philadelphia:
WB Saunders.
10. NSW Health: Policy Directive PD2012_070 Isolated Patients Travel and Accommodation
Assistance Scheme (IPTAAS) Policy Framework.
11. Al-Kuran O, Al-Mehaisen L, Bawadi H et al (2011). The effect of late pregnancy
consumption of date fruit on labour and delivery. J Obstet Gynaecol. 2011;31(1):29-31.
12. Smith CA, Crowther CA, Grant SJ (2013). Acupuncture for induction of labour. Cochrane
Database of Syst Rev (8):CD002962.
13. Smith, C.A.(2003).Homoeopathy for induction of labour. Cochrane Database of Syst Rev
(4):CD003399.
14. Kavanagh J, Kelly AJ, Thomas J(2005). Breast stimulation for cervical ripening and
induction of labour. Cochrane Database of Syst Rev (3):CD003392.
15. Kavanagh J, Kelly AJ, Thomas J (2001). Sexual intercourse for cervical ripening and
induction of labour. Cochrane Database of Syst Rev (2): CD003093.
16. Kelly AJ, Kavanagh J, Thomas J (2013). Castor oil, bath and/or enema for cervical priming
and induction of labour. Cochrane Database of Syst Rev (7): CD003099.
17. Mandruzzato G, Alfirevic Z, Chervenak F et al (2010) Guidelines for the management of
postterm pregnancy. J Perinat Med 38(2): 11119.
18. Boulvain M, Stan C, Irion O (2005) Membrane sweeping for induction of labour. Cochrane
Database Syst Rev(1): CD000451.
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19. de Miranda E, van der Bom JG, Bonsel GJ et al (2006) Membrane sweeping and
prevention of post-term pregnancy in low-risk pregnancies: a randomised controlled trial.
BJOG 113(4): 40208.
20. Yildirim G, Gungorduk K, Karadag OI et al (2010) Membrane sweeping to induce labor in
low-risk patients at term pregnancy: a randomised controlled trial. J Matern Fetal Neonatal
Med 23(7): 68187.
21. Moore ER, Anderson GC, Bergman N, Dowswell T (2012). Early skin-to-skin contact for
mothers and their healthy newborn infants. Cochrane Database of Syst Rev (5)
:CD003519.
22. NICE (2008) Induction of labour clinical guideline. National Collaborating Centre for
Womens and Childrens Health. Commissioned by the National Institute for Health and
Clinical Excellence. London: RCOG Press.
23. ACOG (2004) Management of Postterm Pregnancy. ACOG Practice Bulletin 55: American
College of Obstetricians and Gynecologists.
24. Heimstad R, Romundstad PR, Hyett J et al (2007) Women's experiences and attitudes
towards expectant management and induction of labor for post-term pregnancy. Acta
Obstet Gynecol Scand 86(8): 95056.
25. Divon MY & Feldman-Leidner N (2008) Postdates and antenatal testing. Semin Perinatol
32(4): 295300.
26. Government of South Australia, Department of Health. Perinatal Practice
Guidelines.Available at URL: http://www.health.sa.gov.au/ppg
27. NSW Health: Policy Directive 2011_075 Maternity - Oxytocin for the Induction of Labour at
or Beyond Term
28. Briscoe D, Nguyen H, Mencer M et al (2005) Management of pregnancy beyond 40 weeks'
gestation. Am Fam Physician 71(10): 193541.
29. Siozos C & Stanley KP (2005) Prolonged pregnancy. Curr Obstet Gynaecol 15: 7379.
30. Olesen AW, Westergaard JG, Olsen J (2003) Perinatal and maternal complications related
to postterm delivery: a national register-based study, 1978-1993. Am J Obstet Gynecol
189(1): 22227.
31. Clark SL & Fleischman AR (2011) Term pregnancy: time for a redefinition. Clin Perinatol
38(3): 55764.
32. Yurdakok M (2011) Meconium aspiration syndrome: do we know? Turk J Pediatr 53(2):
12129.
33. Morris JM, Thompson K, Smithey J et al (2003) The usefulness of ultrasound assessment
of amniotic fluid in predicting adverse outcome in prolonged pregnancy: a prospective
blinded observational study. BJOG 110(11): 98994.
34. Lam H, Leung WC, Lee CP et al (2006) Amniotic fluid volume at 41 weeks and infant
outcome. J Reprod Med 51(6): 48488.
35. Singh T, Sankaran S, Thilaganathan B et al (2008) The prediction of intra-partum fetal
compromise in prolonged pregnancy. J Obstet Gynaecol 28(8): 77982.
36. Khooshideh M, Izadi S, Shahriari A et al (2009) The predictive value of ultrasound
assessment of amniotic fluid index, biophysical profile score, nonstress test and fetal
movement chart for meconium-stained amniotic fluid in prolonged pregnancies. J Pak Med
Assoc 59(7): 47174.
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Maternity - Management of Pregnancy


Beyond 41+0 Weeks Gestation

37. Grivell RM, Alfirevic Z, Gyte GM et al (2010) Antenatal cardiotocography for fetal
assessment. Cochrane Database Syst Rev(1): CD007863.
38. Australian College of Midwives (2013). National Midwifery Guidelines for Consultation and
Referral.3rd ed. Australian College of Midwives, Canberra. Available at:
http://midwives.rentsoft.biz/lib/pdf/documents/National/Guidelines2013.pdf
39. NSW Health (2011): Guideline GL2011_012 Maternity - Decreased Fetal Movements in
the Third Trimester. NSW Health, Sydney. Available at:
http://www0.health.nsw.gov.au/policies/gl/2011/GL2011_012.html
40. Gulmezoglu AM, Crowther CA, Middleton P et al (2012) Induction of labour for improving
birth outcomes for women at or beyond term. Cochrane Database Syst Rev 6: CD004945.
41. Hussain AA, Yakoob MY, Imdad A et al (2011) Elective induction for pregnancies at or
beyond 41 weeks of gestation and its impact on stillbirths: a systematic review with metaanalysis. BMC Public Health 11 Suppl 3: S5.
42. Guidelines GL2014_004 Maternity-Supporting women in their next birth after caesarean
section (NBAC)
43. Khireddine I et al (2013). Induction of labor and risk of postpartum hemorrhage in low risk
parturients. PLoS One: 8(1):e54858.
44. Standing Council on Health, 2012: National Maternity Services Capability Framework

5. ATTACHMENT 1
Consumer Brochure - Pregnancy Beyond 41+0 weeks: Information about your options
Available on the next two pages is a printable version of the Consumer Brochure.

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